Path Dependency, or Why History Makes It Difficult but Not Impossible to Reform Health Care Systems in a Big Way

ABSTRACT The idea of path-dependency is applied to an examination of health policy reform in Germany, France, Great Britain and the United States. In the path-dependent model, actors are hemmed in by existing institutions and structures that channel them along established policy paths. Therefore, in any system, big (non-incremental) change is unlikely. However, sometimes we do observe big change. Why? By developing the interplay of structure with conjuncture, the occasional accomplishment of big change - in spite of path dependency - can be systematically understood.